NPIMap

Organization Active NPI

Pine Street Inn, Inc.

  • Physical Disabilities Residential Treatment Facility
  • Dorchester Center, MA
National Provider Identifier
1639337280
Registry record updated May 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X
Legal business name
PINE STREET INN, INC.
Practice address
28 Rockwell St
Dorchester Center, MA 02124-4438
Phone
(617) 892-8802
Fax
(617) 825-9020
NPI assigned
May 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Terrence B Gagne
Title
Chief Financial Officer
Phone
(617) 892-9116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Disabilities Residential Treatment Facility 320700000X Primary

Addresses

Primary practice location

28 Rockwell St
Dorchester Center, MA 02124-4438

Mailing address

444 Harrison Ave
Boston, MA 02118-2404
Phone (617) 482-4944

Other identifiers 1

IdentifierTypeStateIssuer
1803492MedicaidMA

National Provider Directory

National Provider Directory
Tax ID family
Pine Street Inn4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212105600000",
    "number": "1639337280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 HARRISON AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182404",
            "telephone_number": "617-482-4944",
            "fax_number": "617-451-1890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 ROCKWELL ST",
            "city": "DORCHESTER CENTER",
            "state": "MA",
            "postal_code": "021244438",
            "telephone_number": "617-892-8802",
            "fax_number": "617-825-9020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE STREET INN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-30",
        "last_updated": "2008-05-30",
        "status": "A",
        "authorized_official_last_name": "GAGNE",
        "authorized_official_first_name": "TERRENCE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "617-892-9116",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1803492",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorchester Center, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.